Variation in European antibiotic use

Abstract

Otto Cars and colleagues (June 9, p 1851)1Cars O Mölstad S Melander A Variation in antibiotic use in the European Union.Lancet. 2001; 357: 1851-1853Summary Full Text Full Text PDF PubMed Scopus (624) Google Scholar report their anaylsis of data purchased from the Institute for Medical Statistics on antibiotic sales in the European Union. They note a striking difference in outpatient antibiotic use between Belgium and the Netherlands.We agree with Cars and colleagues that physicians' and patients' attitudes to antibiotics partly explain these national differences,2Butler CC Rollnick S Pill R Understanding the culture of prescribing: qualitative study of GP's and patients' perceptions of antibiotics for sore throats.BMJ. 1998; 317: 637-642Crossref PubMed Scopus (571) Google Scholar, 3Coenen S Van Royen P Vermeire E Hermann I Denekens J Antibiotics for coughing in general practice: a qualitative decision analysis.Fam Pract. 2000; 17: 380-385Crossref PubMed Scopus (65) Google Scholar but feel that the following differences in health-care systems also deserve consideration as possible determinants:Family physicians in the Netherlands have personal patient lists, which might encourage more frugal prescribing than the fee-for-service system in Belgium.The Netherlands has a nationwide-structure of family physician peer-review groups, with collaborating pharmacists, to promote rational prescribing through audit and feedback; Belgium has no such structure.About 80–85% of outpatient antimicrobial prescriptions are for respiratory-tract infections. There is no evidence that antibiotics shorten the duration of symptoms in most instances of the common cold, acute otitis media, sore throat or tonsillitis, sinusitis, and acute bronchitis.4Arroll B Kenealy T Antibiotics for the common cold (Cochrane Review). The Cochrane Library, Issue 4. Update Software, Oxford2000Google Scholar Antibiotics are indicated only for patients at greater risk of complications or a with a long-lasting disease course. Unnecessary antibiotic prescribing is associated with adverse effects, opportunity costs, encouragement of reconsulting and increasing resistance. Even in the Netherlands, it was estimated that antibiotics were most probably indicated for only half of those who received them for these types of disorders.5De Melker RA Efficacy of antibiotics in frequently occurring airway infections in Family Practice.Ned Tijdschr Geneeskd. 1998; 142: 452-456PubMed Google ScholarInappropriate antibiotic prescribing should, therefore, remain prominent on the research agenda; we are doing intervention studies to reduce the prescription of antibiotics for respiratory-tract infections in Belgium and the Netherlands, as well as completing a descriptive study, with colleagues from Barcelona, Spain, and Cardiff, UK, of patients' attitudes to these disorders and antibiotic treatment. Otto Cars and colleagues (June 9, p 1851)1Cars O Mölstad S Melander A Variation in antibiotic use in the European Union.Lancet. 2001; 357: 1851-1853Summary Full Text Full Text PDF PubMed Scopus (624) Google Scholar report their anaylsis of data purchased from the Institute for Medical Statistics on antibiotic sales in the European Union. They note a striking difference in outpatient antibiotic use between Belgium and the Netherlands. We agree with Cars and colleagues that physicians' and patients' attitudes to antibiotics partly explain these national differences,2Butler CC Rollnick S Pill R Understanding the culture of prescribing: qualitative study of GP's and patients' perceptions of antibiotics for sore throats.BMJ. 1998; 317: 637-642Crossref PubMed Scopus (571) Google Scholar, 3Coenen S Van Royen P Vermeire E Hermann I Denekens J Antibiotics for coughing in general practice: a qualitative decision analysis.Fam Pract. 2000; 17: 380-385Crossref PubMed Scopus (65) Google Scholar but feel that the following differences in health-care systems also deserve consideration as possible determinants: Family physicians in the Netherlands have personal patient lists, which might encourage more frugal prescribing than the fee-for-service system in Belgium. The Netherlands has a nationwide-structure of family physician peer-review groups, with collaborating pharmacists, to promote rational prescribing through audit and feedback; Belgium has no such structure. About 80–85% of outpatient antimicrobial prescriptions are for respiratory-tract infections. There is no evidence that antibiotics shorten the duration of symptoms in most instances of the common cold, acute otitis media, sore throat or tonsillitis, sinusitis, and acute bronchitis.4Arroll B Kenealy T Antibiotics for the common cold (Cochrane Review). The Cochrane Library, Issue 4. Update Software, Oxford2000Google Scholar Antibiotics are indicated only for patients at greater risk of complications or a with a long-lasting disease course. Unnecessary antibiotic prescribing is associated with adverse effects, opportunity costs, encouragement of reconsulting and increasing resistance. Even in the Netherlands, it was estimated that antibiotics were most probably indicated for only half of those who received them for these types of disorders.5De Melker RA Efficacy of antibiotics in frequently occurring airway infections in Family Practice.Ned Tijdschr Geneeskd. 1998; 142: 452-456PubMed Google Scholar Inappropriate antibiotic prescribing should, therefore, remain prominent on the research agenda; we are doing intervention studies to reduce the prescription of antibiotics for respiratory-tract infections in Belgium and the Netherlands, as well as completing a descriptive study, with colleagues from Barcelona, Spain, and Cardiff, UK, of patients' attitudes to these disorders and antibiotic treatment.